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The hidden power of corporations

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"Money, we once agreed, gave the owner, the capitalist, the controlling power in the enterprise. So it still does in small businesses. But in all large firms the decisive power now lies with a bureaucracy that controls, but does not own, the requisite capital. This bureaucracy is what the business schools teach their students to navigate, and it is where their graduates go. But bureaucratic motivation and power are outside the central subject of economics. We have corporate management, but we do not study its internal dynamics or explain why certain behaviors are rewarded with money and power. These omissions are another manifestation of fraud."

But still we do not learn. Readers might like to view the list of the CDC Foundation corporate partners (motto: "Together our impact is greater") which includes the Coca-Cola Company but also virtually every other major corporation, and every major pharmaceutical company [4]. At least Coca Cola was not supposed to improve your health.

McKee and colleagues usefully draw attention to corporate strategies that serve shareholder interests at the expense of public health; these impacts are often obscured by sophisticated marketing and public relations (1). Of particular interest is why so many of us, including doctors, fail to recognise this common pattern; as we are part of the problem, an understanding of this ‘blindspot’ and its determinants is needed to guide management.

Several psychological mechanisms are relevant. First, as a species we are notably poor at recognising our vulnerability to persuasion. Complementing this lack of insight, we doctors like to think that our clinical decisions are based on scientific rationality (2); marketers reinforce this vanity with carefully curated ‘evidence’, often coupled with images that appeal to our healing role. Seeing ourselves as rational prescribers, we rankle at suggestions that we are influenced by marketing but, somewhat ironically, denial of vulnerability is itself a key risk factor for being influenced (3).

A related problem arises from conflicts of interest in medicine and, controversially, how these should be identified and managed. Disclosing conflicts, as McKee and colleagues note, is necessary but not sufficient to manage associated bias (4). As with vulnerability to persuasion, we are also rather better at reckoning conflicts in our colleagues than ourselves (5). This blindspot also plays a role in distorting the medical literature, as can be seen from authors’ disclosures that downplay relationships, financial and otherwise, with for-profit corporations (6). The tendency to sanitise our links to vested interests is hard to resist; by outwardly satisfying ethical and editorial requirements, it helps us to feel better and to get published, while keeping corporate power hidden from view.

Where many of the rules and regulations may be framed on countrywide basis , the writ of several corporations runs transnationally and the reach and leap could be phenomenal. The power they possess could be an useful link when they are in consonance and synchronise with academic needs of scientists of various departments/ institutes / countries. Quite on some occasions the theme and thrust of projects / trials may not necessarily be of significant relevance to the local population , yet may be carried out to include diverse populations. The degree of penetration of corporations in science / research can be variable and on occasions can assume dominance with deviations from general norms. The hidden power cannot be measured but perceived through influences and actions. In the modern world , commerce tends to have a distinct role in most areas of human endeavour ; explicit or hidden power will continue to play its role unless the crudity and it's consequences grossly violate the standard norms. Murar E Yeolekar , Mumbai